Research Article|Articles in Press

Impact of robotic access on outcomes after lung cancer surgery in France: Analysis from the Epithor database

Open AccessPublished:March 17, 2023DOI:
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      We aimed to compare postoperative outcomes after pulmonary resection for lung cancer after open thoracotomy (OT), video-assisted (VATS) and robotic-assist (RA) thoracic surgery using a propensity score analysis.


      From 2010 to 2020, 38,423 patients underwent resection for lung cancer. 58.05% (n=22,306) were operated by thoracotomy, 35.35% (n=13,581) by VATS and 6.6% (n=2,536) by RA. A propensity score was used to create balanced groups with weighting. End points were: in-hospital mortality, postoperative complications and length of hospital stay, reported by odds ratios (OR) and 95% confidence intervals (CI).


      VATS decreased in-hospital mortality compared to OT (OR=0.64(0.58-0.79);p<0.0001) but not compared to RA (OR=1.09(0.77-1.52);p=0.61). VATS reduced major postoperative complications compared to OT (OR=0.83(0.76-0.92);p<0.0001) but not RA (OR=1.01(0.84-1.21);p=0.17). VATS reduced prolonged air leaks rate compared to OT (OR=0.9(0.84-0.98);p=0.015) but not RA (OR=1.02(0.88-1.18);p=0.77). As compared to OT, VATS and RA decreased: the number of atelectasis, respectively (OR=0.57(0.50-0.65);p<0.0001) and (OR=0.75(0.60-0.95);p=0.016); the number pneumonia (OR=0.75 (0.67-0.83);p<0.0001) and (OR=0.62(0.50-0.78);p<0.0001); the number of postoperative arrhythmias (OR=0.69(0.61-0.78);p<0.0001) and (OR=0.75(0.59-0.96);p=0.024). Both VATS and RA were resulted in shorter hospital stays (-1.91days (-2.24;-1.58); p<0.0001 and -2.73days (-3.1;-2.36);p<0.0001, respectively).


      RA seemed to decrease postoperative pulmonary complications as VATS compared to OT. VATS decreased postoperative mortality as compared to RA and OT.

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      Key words

      Glossary of abbreviations:

      ASA (American Society of Anesthesiologists), BMI (Body Mass Index), CI (Confidence Interval), DFS (Disease Free Survival), FEV1 (Forced Expiratory Volume in One Second), HR (Hazard Ratio), IPTW (Inverse Probability for Treatment Weighting), IHM (In-hospital mortality), LOS (Length of Hospital Stay), LC (Lung Cancer), NNIS (National Nosocomial Infection Surveillance Risk index), OR (Odds Ratio), OS (Overall survival), OT (Open Thoracotomy), PAL (Prolonged Air Leaks), PS (Propensity Score), RA (Robotic-Assist), RCT (Randomized Controlled Trial), VATS (Video-Assisted Thoracic Surgery), WHO (World Health Organization)